Kayalar Murat, Bal Emin, Toros Tulgar, Süğün S Tahir, Özaksar Kemal, Gürbüz Yusuf
Hand and Microsurgery Hospital, İzmir, Turkey.
Acta Orthop Traumatol Turc. 2011;45(3):175-84. doi: 10.3944/AOTT.2011.2429.
In this study we aimed to evaluate the results of the direct-flow neurovascular island flap (NIF) transfers in pulp defects.
We reviewed the records of 96 patients with 115 NIF transfers performed for pulp defect reconstruction. The injury mechanism was crush type injury in 70 patients (72.9%). Ninety-three patients (97%) were emergency cases. Pulp reconstruction was performed by means of pedicled island flap transfer. The results were evaluated with proximal interphalangeal joint range of motion, the Semmes Weinstein monofilament test, static two-point discrimination and cold intolerance assessments. The relations between the injury mechanism, patient satisfaction, cold intolerance and scar problems were analyzed. Also, the association between skin grafting and hook nail deformity was investigated. The level of significance was set at p<0.05.
All flaps survived. The mean follow-up time was 41±20.3 (range: 12-108) months. We observed proximal interphalangeal joint flexion contracture in 11 (9.5%) cases. In seven of these, the limitation was less than 10 degrees. Hook nail deformity was seen in 8 fingers (7%). Cold intolerance was found in 16 (17%) cases. Semmes Weinstein monofilament and static-two point discrimination tests of flaps revealed satisfactory results. There was no relation between the injury mechanism and cold intolerance, patient satisfaction and scar problems (p>0.05). Among patients, 91.7% were satisfied with their results.
The transfer of direct-flow island flaps, from the same finger, causes minimal morbidity on the donor site and appears to be a safe method, providing satisfactory functional and aesthetic results in the reconstruction of pulp defects.
在本研究中，我们旨在评估直流神经血管岛状皮瓣（NIF）转移修复牙髓缺损的效果。
我们回顾了96例患者115次进行NIF转移修复牙髓缺损的记录。损伤机制为挤压伤的患者有70例（72.9%）。93例（97%）为急诊病例。采用带蒂岛状皮瓣转移进行牙髓重建。通过近端指间关节活动范围、Semmes Weinstein单丝试验、静态两点辨别觉和冷不耐受评估来评估结果。分析损伤机制、患者满意度、冷不耐受和瘢痕问题之间的关系。此外，还研究了植皮与钩甲畸形之间的关联。显著性水平设定为p<0.05。
所有皮瓣均存活。平均随访时间为41±20.3（范围：12 - 108）个月。我们观察到11例（9.5%）出现近端指间关节屈曲挛缩。其中7例，受限小于10度。8个手指（7%）出现钩甲畸形。16例（17%）存在冷不耐受。皮瓣的Semmes Weinstein单丝试验和静态两点辨别觉测试结果令人满意。损伤机制与冷不耐受、患者满意度和瘢痕问题之间无关联（p>0.05）。患者中，91.7%对结果满意。
同一手指的直流岛状皮瓣转移在供区造成的并发症最少，似乎是一种安全的方法，在牙髓缺损重建中能提供令人满意的功能和美学效果。
